Endometriosis

What is endometriosis? Endometriosis is deposits of endometrial tissue (cells from inner lining of uterus) into the surfaces of abdomen. These deposits occur over the ovaries, tubes, intestines and peritoneal surfaces. If I have endometriosis what symptoms can I experience? The following symptoms are common with endometriosis:

painful periods

lower abdominal pain & lower back pain

painful intercourse especially with deep penetration (dyspareunia)

infertility (inability to conceive)

nausea, vomiting, dizziness and fainting attacks during periodsWhat are the causes for endometriosis?

No one knows for sure what causes endometriosis. One theory is based on the belief that menstrual fluid that normally flows out of the vagina, moves backward into the uterus through the tubes and drips into the abdominal cavity. Pieces of the uterine lining in this fluid attach themselves and grow on other organs of pelvis & abdomen. Other theory is that endometriosis may be caused by modulation of the immune system.

What happens in endometriosis?

Under the influence of the female hormone estrogen, the endometriotic implants to grow causing pain and swelling. These implants outside the uterus have no way to leave the body and become inflamed and swollen. If endometriosis occurs in ovaries it can cause cyst (blood filled sac) formation.

The deposits of endometrial tissue bleed during menstruation resulting in cyst formation in the ovaries. The implants on tissue and peritoneal surfaces cause an inflammatory reaction with resultant adhesion formation between the various pelvic organs destroying the tubo-ovarian relationship. In these cases even though the tube is patent, there is difficulty in egg pick up and its transport to the uterus.

Do the symptoms depend upon the severity of the disease?

Symptoms can start very shortly after your first period (menarche) or show up in the later years. Pain is a common symptom of endometriosis. The severity of pain however does not appear to be linked exclusively to how severe and extensive your endometriosis is.

Where is endometriosis found?

Endometriosis mainly affects the organs and structures of the pelvis

ovaries, uterus, fallopian tubes

cul-de-sac (extension of the abdominal cavity, like a pouch, that lies between the rectum and the back of the uterus)

Endometriosis can also be found in the lungs, diaphragm, brain, small and large bowel but this is very rare.

How is endometriosis diagnosed?

Endometriotic ovarian cysts can be diagnosed with help of transvaginal ultrasound. However for a definite diagnosis looking through a laparoscope at the internal organs and taking a sample of the endometrial tissue for analyses is essential.

How does one suspect endometriosis?

Previously non painful menstruation becoming painful & pain during sexual intercourse raises a suspicion. Endometriosis may also be associated with difficulty in conceiving. Presence of cysts on ultrasound with thick material within (internal echoes) also indicates endometriosis.

What is the treatment of endometriosis?

There are many different treatment modalities available for endometriosis. They range from medical treatment which includes the use of hormonal drugs to surgical treatment which is done by the help of laparoscope or by open surgery. Pain Medication: Hormones in the form of OC pills (estrogen & progesterone), Danazol (weak male hormone) & GnRH agonist (gonadotropin releasing hormone agonist) can be given. Pain relief can also be achieved with mefenamic acid, NSAIDS (ibuprofen, diclofenac, aspirin) and morphine group of drugs (Tramadol). Surgery: Laparoscopic surgery is the best form of treatment for endometriotic cysts whereby the cyst is drained and part of cyst wall is sent for biopsy and the rest is fulgurated (burnt) with bipolar cautery. Adhesiolysis (releasing adhesions) during laparoscopy restores the tubo-ovarian relationship and improves tubal function. Sometimes open surgery may be required. Infertility treatment: Infertility management can be surgical ablation of endometriotic implants immediately followed by medical or injectable treatment for ovulation induction with either timed intercourse or IUI (intra uterine insemination). IVF (in-vitro-fertilization) may be the only option in severe endometriosis or failure to conceive despite the above-mentioned treatment. Fibroids and Infertility Fibroids are benign tumors of the uterus. They are also called uterine leiomyomas, or simply myomas. Fibroids grow from the muscle cells of the uterus and may protrude from the inside (submucus) or outside surface (subserous) of the uterus or they may be contained within the muscular wall (intramural).Fibroids are very common. About 25 percent of women in their childbearing years will have signs of fibroids that can be detected by a pelvic examination, although not all will experience symptoms.

PREMATURE OVARIAN FAILURE

Premature Ovarian Failure (POF) is better termed as premature ovarian insufficiency, which appears to be a more accurate term as some women may still conceive in this stage of diminishing ovarian activity. Premature menopause, is the term used for complete loss of ovariian function before age 40. It is characterized by menopausal levels of follicle stimulating hormone (FSH), low estrogen levels and absence of menses/ scanty delayed menses. It has been estimated that POF affects 1% of the total female population in reproductive age.
â€¢ The average age of natural menopause is around 54 years. The ovary of a female contains fixed number of oocytes (eggs) from which she ovulates about 400 during the whole reproductive period. The remaining either undergo atresia or apoptosis without making mature eggs. Hormonally, POF is defined by abnormally low levels of estrogen and high levels of FSH, which demonstrate that the ovaries are no longer responding to circulating FSH by producing estrogen and developing fertile eggs. The ovaries will likely appear shriveled. Age of onset can be as early as the teenage years but varies widely. If a girl never begins menstruation, it is called primary ovarian failure. The age of 40 was chosen as the cut-off point for a diagnosis of POF.
â€¢ Infertility is the result of this condition, and is the most discussed problem resulting from it, but there are additional health implications of the problems like osteoporosis or decreased bone density due to an insufficiency of estrogen. There is also an increased risk of heart disease, hypothyroidism due to hashimotoâ€™s thyroiditis, addisonâ€™s disease, and other auto-immune disorders. Women suffering from POF usually experience menopausal symptoms, which are generally more severe than the symptoms found in women acheiving menupase at older age.

One frequent cause is autoimmune ovarian disease which damages maturing follicles, but leaves the primordial follicles intact. Also, in some women FSH may bind to the FSH receptor site, but be inactive. By lowering the endogenous FSH levels with ethinyl estradiol (EE) or with a GnRHa the receptor sites are freed and treatment with exogenous recombinant FSH activates the receptors and normal follicle growth and ovulation can occur. Since the serum anti-mullerian hormone (AMH) level is correlated with the number of remaining primordial follicles some researchers believe the above two phenotypes can be distinguished by measuring serum AMH levels.